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What does retinoscopy give us?
a starting point for the exam
What are the general prescribing pearls to look at?
- Symptoms
- Child's age
- Binocularity
- VA sc
- VA cc or with modified rx
- Prior rx
What are 3 things we need to think about when prescribing glasses to pediatric patients?
- let the child pick the frame
- make sure frames are "kid friendly"
- make sure child uses them properly
How would we show a parent what myopia looks like?
have them look through a plus lens
How would we show a parent what hyperopia looks like?
have them look through minus lenses at near
How do we explain astigmatism to parents?
explain that the cornea is football shaped instead of perfectly round and causes light to focus in different spots
What are some associations with Hyperopia?
- decreased near visual skills
- poor reading comprehension
- poor educational achievement
- poor attention
- juvenile delinquency
According to MEPEDS, what population group demonstrates the most hyperopia? least hyperopia?
most = Hispanic
least = Asian
According to the Baltimore Pediatric Eye Disease Study, what population demonstrates more hyperopia?
caucasian
What is the full term average of hyperopia in infants and toddlers?
+2.00
When is there a significant decrease in hyperopia in infants/toddlers?
3-9 months
When is emmetropization generally reached?
18 months
What trend does the BIBS study show between 3-18 months?
At 3 months, higher than +3 most common, gradually decreasing
By 18 months, biggest concentration around +1 and +2
Ingram's study showed that 9% of infants that were > six months and had +4D or more, had a higher risk of?
- 20% risk of vision defects
- amblyopia
- strabismus
According to Atkinson & Braddick, infants with > +3.50 D are more likely to have what?
12 times more prone to strabismus by age 4
6 times more prone to amblyopia
Risk of strabismus is common after what refractive error?
> +3.00
Risk of bilateral amblyopia is found with what refractive error?
+5.00
The VIP study showed that what percent of preschoolers were > +3.25?
11.7 %
The PEDIG study evaluated what age group?
1-2 years
The PEDIG study used what range of refractive errors?
+3.00 to +6.00
NO strabismus
What counted as a failure for the PEDIG study?
- Decreased stereo
- Decreased VA
- Manifest strabismus
- Small to moderate benefit vs. no benefit
1 out of 6 children who are not reading proficiently by which grade do not graduate from high school on time?
3rd grade
What percent of low, below-basic readers drop out or fail to finish high school on time?
23%
Literacy levels are dropping in what populations since 2019?
- all gorups
- of color, low income, or learning to speak English had steepest declines
TOPEL shows worse early literacy in kindergarten using what categories?
- print knowledge
- definitional vocabulary
- phonological awareness
What was the result of the Rosner & Rosner study?
significantly lower achievement test scores among children with refractive error is greater than +1.25 dry
What was the result of the vanRijn study?
full correction improved 1 minute reading score by 13%
What was the primary and secondary outcomes of CHICS?
primary = change in reading comprehension
secondary = change in attention, visual function
What were the results of CHICS?
- no change in reading comprehension
- improved attention
Over minusing kids by 2D can cause what?
ADHD symptoms
What RE does the AAO recommend prescribing glasses for a child 3 and under?
> +4.50
When does the AAO recommend prescribing glasses for a child older than 4?
- as necessary to improve acuity or alleviate esotropia
What RE's does the AOA recommend prescribing glasses for in infants, young children, and adolescents?
Infants = +3.50
Young child = +2.50
Adolescence = +1.50
Generally, when do we consider correcting hyperopia in infants?
esotropia
anisometropia
consider > +5.00
Generally, when do we consider correcting hyperopia in toddlers?
esotropia
anisometropia
consider > 3.50
What do we do when prescribing glasses for a hyperopic toddler or preschooler from cycloplegic values?
cut cycloplegia 1-2D symmetrically
When do we correct hyperopia in preschoolers?
esotropia
anisometropia
Ages 4+
- Rx greater than or equal to 2.5-
- if less, but stereopsis, near va issues, symptoms
What symptoms indicate hyperopia correction for a school aged child?
- blurry vision (consistent w/RE)
- headaches when reading
- gets blurry as reading
- below grade level for reading
- tired when reading
- avoids reading
What age group has the greatest amount of astigmatism?
infants
What is the rarest form of astigmatism?
oblique
Oblique astigmatism puts a child at risk for what?
amblyopia
When do we prescribe glasses for oblique astigmatism?
1D at 1 year and up
What did the NICER study show?
astigmatism prevalence was unchanged between 6-7 to 15-16 years but individual patient changes possible
What are the 3 things found in an astigmatism exam?
- retinoscopy
- keratometry
- topography
What does Keratometry show?
- corneal astigmatism
- axis
- magnitude
- changes
What is topography used more for?
irregular astigmatism or keratoconus
Small amounts of what type of astigmatism may indicate accommodative dysfunction?
against the rule astigmatism
When is there concerns about vision development/amblyopia for toddlers with astigmatism?
rx greater than equal to 2.50D at 15+ months
rx greater than equal to 2.00 at 2+ years
look at symptoms also
Uncorrected astigmatism can lead to what?
decreased academic readiness and literacy
Uncorrected astigmatism can cause lower scores in what areas?
- personal and social development
- language and literacy
- physical development
- personal/social communication
- fine motor
The Reading FLuency in School-Aged Children with Bilateral Astigmatism showed what?
oral reading fluency significantly reduced with greater than or equal to 1.00 D of astigmatism uncorrected
showed importance of wearing glasses
When do we consider correcting astigmatism in preschoolers?
rx greater than or equal to 1.50 D at 4+ years
full rx w/adaptation
What do we consider when correcting astigmatism in school-aged children?
rx greater than 0.75
VA levels, text size, symptoms
